Apr 20
Antimicrobial Stewardship in Aged Care
What Every Infection Control Team Needs to Know
Antimicrobial resistance is not a future threat - it's already happening in your facility. For
Infection Control teams in aged care, antimicrobial stewardship (AMS) is one of the
most powerful tools you have to protect residents, support safe prescribing, and meet
your regulatory obligations in Australia and New Zealand.
Here's what your whole team needs to know.
Here's what your whole team needs to know.
What Is Antimicrobial Stewardship- and Why Does It Matter in Aged Care?
Antimicrobial stewardship (AMS) is the ongoing effort by a provider and its clinical team
to optimise the use of antimicrobial medicines, including antibiotics, antivirals,
antifungals, and antiparasitic agents, while minimising their use.
The goal is not to withhold treatment. It's to ensure the right medicine is given to the
right resident at the right dose for the right duration.
- Approximately 50% of antimicrobial prescriptions in Australian residential aged care facilities (RACFs) are deemed inappropriate.
- Critical antimicrobial resistance (AMR) reports show in Australia, AMR rose 25.2% year on year.
- Aged care homes are now showing the highest growth in antimicrobial use compared with any other community setting.
- Inappropriate use drives the development of multidrug-resistant organisms (MDROs) — organisms that are increasingly difficult and costly to treat.
AMS is not a back-of-house compliance exercise. It is front-line resident safety.
Source: Antimicrobial Use in the Community 2024 Report (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2025)
Why Aged Care Residents Are Particularly Vulnerable
Residents in aged care present unique challenges for diagnosing and managing
infections. Understanding these vulnerabilities is the first step in responding effectively.
- typical infection presentations - older adults often don't develop the classic signs of infection (fever, localised pain, raised white cell count). Confusion, reduced appetite, or a fall may be the only indicators.
- High comorbidity burden and compromised immunity - multiple chronic conditions, polypharmacy, and age-related immune changes make residents both more susceptible to infection and more difficult to assess.
- Asymptomatic bacteriuria (ASB) over-treatment - bacteria in the urine without symptoms is common in older adults and does not require antibiotic treatment. Yet urine cultures are frequently ordered and, the resident treated with an antibiotic unnecessarily, accelerating resistance.
- Broad-spectrum antibiotic overuse - when diagnostic uncertainty leads to "cover all bases" prescribing, broad-spectrum agents are used more than necessary, driving MRO development across the entire facility, and not just for the resident receiving the antibiotic.
These vulnerabilities make the Infection Prevention and Control (IPC) Lead's role in AMS not just helpful, but essential.
Sources: ACSQHC Aged Care IPC Guide Version 1.1 (ACSQHC, 2025); Aged Care National Antimicrobial Prescribing Survey (ACQSC, 2024)
The Regulatory Landscape — Australia and New Zealand
Both countries now have clear, binding requirements for AMS in aged care. This is not
optional.
Australia
- Strengthened Aged Care Quality Standards (effective 1 July 2025)- Outcome 5.2 explicitly requires providers to implement a formal AMS system compliant with contemporary, evidence-based practice.
- The Aged Care Quality and Safety Commission (ACQSC) oversees compliance and has released an AMS Self-Assessment Tool to help facilities review their current activities and identify gaps.
- The Aged Care National Antimicrobial Prescribing Survey (AC NAPS) - coordinated by the National Centre for Antimicrobial Stewardship (NCAS Australia) - has collected national prescribing data since 2015 and serves as a key quality benchmarking tool.
- The ACSQHC Aged Care IPC Guide (August 2024, updated January 2025)
provides practical implementation support for IPC and AMS.
New Zealand
- NZS 8134:2021 Ngā Paerewa Health and Disability Services Standard - Part 5 mandates infection prevention and antimicrobial stewardship for all aged care providers.
- The Health Quality & Safety Commission (HQSC) Te Tāhū Hauora leads the national AMS strategy.
- The New Zealand Antimicrobial Resistance Action Plan (2017, ongoing) frames the broader national response.
- AMS and IPC governance now fall under Health New Zealand | Te Whatu Ora.
Sources: Strengthened Aged Care Quality Standards (Department of Health and Aged Care [DoHAC], 2025); NZS 8134:2021 Ngā Paerewa Health and Disability Services Standard (Standards New Zealand, 2021)
Core Elements of an Effective AMS Program in Aged Care
A strong AMS program is multifaceted. No single intervention is sufficient; the evidence
consistently shows that combined approaches yield the best outcomes.
Your program should include:
Your program should include:
- Leadership commitment - the governing body, Medical Director, and Director of Nursing must actively champion AMS as an organisational priority, not merely a compliance checkbox.
- A designated AMS lead, integrated with your IPC system - in most aged care facilities, this will be your IPC lead.
- Evidence-based prescribing guidelines tailored to aged care - age-specific, locally relevant, and regularly reviewed against local resistance patterns.
- Standardised infection assessment protocols - including structured clinical assessment tools that reduce diagnostic guesswork.
- UTI management protocols - implement the "To Dip or Not to Dip" approach to reduce unnecessary dipstick testing and subsequent antibiotic prescribing for asymptomatic bacteriuria.
- Ongoing staff education - accessible, role-specific, and embedded within orientation and annual competency frameworks.
- Resident and family engagement - managing expectations about antibiotics is a core AMS function; families need to understand that withholding treatment can sometimes be the safest choice.
- Surveillance and prescriber feedback - participation in AC NAPS (Australia) provides benchmarking data and supports feedback loops with prescribers.
- Catheter and invasive device minimisation - indwelling urinary catheters are a major driver of unnecessary antibiotic use; minimise use and review regularly.
Sources: ACSQHC Aged Care IPC Guide Version 1.1 (ACSQHC, 2025); NCAS-Australia Aged Care AMS Resources (NCAS-Australia, 2024)
The Infection Control Team's Role in AMS
AMS and IPC are inseparable in aged care. Your team is uniquely positioned to drive
change.
- Champion AMS at the clinical coalface - you see prescribing patterns, assess residents, and know when something doesn't add up.
- Lead nurse-driven UTI assessment protocols - research consistently shows that nurse-led UTI management interventions significantly reduce inappropriate antibiotic prescribing.
- Audit and provide feedback on prescribing data - use AC NAPS or local data to
identify patterns, celebrate improvements, and flag concerns to prescribers and
the leadership team.
- Educate your whole team - from enrolled nurses to allied health and housekeeping staff. Everyone has a role in reducing transmission and supporting appropriate treatment decisions.
- Engage residents and families - your team builds the trust that makes these conversations possible.
- Liaise with GPs, pharmacists, and pathology - AMS is a multidisciplinary effort;
your IPC Lead is the connective tissue linking clinical and prescribing teams.
Practical First Steps for Your Team
If your facility is still building its AMS program, start here:
- Complete the ACQSC AMS Self-Assessment Tool (Australia) - it's free, structured, and maps directly to Outcome 5.2 compliance requirements.
- Participate in AC NAPS (Australia) or engage the HQSC AMS resources (New Zealand) - national benchmarking data is one of the most powerful tools for building the case for change with your governing body.
- Review your UTI management protocol - if it lacks a "To Dip or Not to Dip" decision framework, update it.
- Put AMS on your governance and quality agenda - it needs a standing agenda item, with metrics, and accountable owners.
- Access free NCAS-Australia educational resources - practical, evidence-based,
and designed for aged care settings.
AMS is one of the clearest examples in aged care where good infection control practice and good clinical care are the same. Your team has the expertise, the relationships, and the influence to make this work. The regulatory expectation is now clear - and so is the clinical case.
Start with the self-assessment. Build from there.
Conclusion
Quick Reference: The "Big Three" for IPC Lead
As a takeaway, focus on these three pillars of AMS.
- Regulatory Integration: In Australia, AMS is no longer a "recommendation" but a core requirement under Outcome 5.2. In NZ, it is mandated as part of NZS 8134:2021.
- Diagnostic Stewardship: Shifting the focus from "treating the lab result" (such as asymptomatic bacteriuria) to "treating the resident" is the most effective way to reduce inappropriate prescribing rates.
- Data as Influence: Using the AC NAPS data isn't just for compliance; it is the
evidence the IPC lead needs to have when having difficult conversations with
visiting GPs or nurse practitioners about prescribing practices.
Read more of our blogs on the HUB, IPS’s website.
Questions? Ask EVE for that quick, nagging question, visit the HUB or contact us at
support@infectioncontrol.care
Lyndon Forrest
Managing Director | CEO
Lyndon is the Managing Director of Infection Prevention Services (IPS), bringing over 30 years' experience supporting aged care providers across Australia and New Zealand.
With a background spanning outbreak response, compliance, and infection risk management — alongside hands-on experience leading teams, managing multi-site operations, and navigating business turnaround — he understands both the clinical and organisational pressures aged care providers face. Lyndon holds a Master of Commerce (Industrial Relations), and applies that foundation to the people, process, and growth challenges that come with running a complex healthcare services business.
He is passionate about building the systems and capability that make infection prevention sustainable — not just compliant — and about helping organisations grow their confidence alongside their practice.
Lyndon's focus is straightforward: strengthen operations, develop the right people, and drive proactive infection prevention strategies that protect residents, staff, and communities for the long term.
Lyndon is the Managing Director of Infection Prevention Services (IPS), bringing over 30 years' experience supporting aged care providers across Australia and New Zealand.
With a background spanning outbreak response, compliance, and infection risk management — alongside hands-on experience leading teams, managing multi-site operations, and navigating business turnaround — he understands both the clinical and organisational pressures aged care providers face. Lyndon holds a Master of Commerce (Industrial Relations), and applies that foundation to the people, process, and growth challenges that come with running a complex healthcare services business.
He is passionate about building the systems and capability that make infection prevention sustainable — not just compliant — and about helping organisations grow their confidence alongside their practice.
Lyndon's focus is straightforward: strengthen operations, develop the right people, and drive proactive infection prevention strategies that protect residents, staff, and communities for the long term.
Erica Callaghan
Marketing Manager
Erica Callaghan is a dedicated professional with a rich background in agriculture and nutrient management. Growing up on her family's farm in Mid Canterbury, she developed a deep passion for farming. She currently resides on her partner's arable property in South Canterbury.
In 2017, Erica joined the Farm Sustainability team, focusing on nutrient management and environmental stewardship. In February 2024, she became the Manager of Marketing and Sales at Bug Control New Zealand - Infection Prevention Services, where her passion now includes improving infection prevention outcomes.
Outside of work, Erica loves cooking and traveling, often combining her culinary interests with her explorations in Italy and Vietnam. She enjoys entertaining family and friends and remains actively involved in farm activities, especially during harvest season.
Erica Callaghan is a dedicated professional with a rich background in agriculture and nutrient management. Growing up on her family's farm in Mid Canterbury, she developed a deep passion for farming. She currently resides on her partner's arable property in South Canterbury.
In 2017, Erica joined the Farm Sustainability team, focusing on nutrient management and environmental stewardship. In February 2024, she became the Manager of Marketing and Sales at Bug Control New Zealand - Infection Prevention Services, where her passion now includes improving infection prevention outcomes.
Outside of work, Erica loves cooking and traveling, often combining her culinary interests with her explorations in Italy and Vietnam. She enjoys entertaining family and friends and remains actively involved in farm activities, especially during harvest season.
Toni Sherriff
Clinical Nurse Specialist
Toni is a Registered Nurse with extensive experience in Infection Prevention and Control. Her career began as a kitchen hand and caregiver in Aged Care facilities, followed by earning a Bachelor of Nursing.
Toni has significant experience, having worked in Brisbane’s Infectious Diseases ward before returning home to New Zealand, where she continued her career as a Clinical Nurse Specialist in Infection Prevention and Control within Te Whatu Ora (Health NZ).
Toni brings her expertise and dedication to our team, which is instrumental in providing top-tier infection prevention solutions to our clients.
Toni is a Registered Nurse with extensive experience in Infection Prevention and Control. Her career began as a kitchen hand and caregiver in Aged Care facilities, followed by earning a Bachelor of Nursing.
Toni has significant experience, having worked in Brisbane’s Infectious Diseases ward before returning home to New Zealand, where she continued her career as a Clinical Nurse Specialist in Infection Prevention and Control within Te Whatu Ora (Health NZ).
Toni brings her expertise and dedication to our team, which is instrumental in providing top-tier infection prevention solutions to our clients.
Julie Hadfield
Accounts & Payroll
Julie is experienced in Accounts & Payroll Administration & after a long career in both the Financial & Local Government Sectors, is now working with our team. Julie brings her strong time management & organisational skills to our team, which is important to keep the company running in the background to enable the rest of our team to provide top notch service to all of our clients.
Julie is experienced in Accounts & Payroll Administration & after a long career in both the Financial & Local Government Sectors, is now working with our team. Julie brings her strong time management & organisational skills to our team, which is important to keep the company running in the background to enable the rest of our team to provide top notch service to all of our clients.
Andrea Murray
Content Editor
I attended Otago University in NZ and graduated as a Dental Surgeon. After 40 years in the profession, I retired in 2022. Infection prevention knowledge was part of everyday practice, dealing with sterilisation, hand hygiene, and cleaning.
Before retiring, I began doing some editing and proofreading for Bug Control as I am interested in the subject and in the English language. During the COVID-19 lockdown, I attended the ACIPC course "Introduction to Infection Prevention and Control", which increased my interest in the subject. I now work part-time as the Content Editor for the company.
I attended Otago University in NZ and graduated as a Dental Surgeon. After 40 years in the profession, I retired in 2022. Infection prevention knowledge was part of everyday practice, dealing with sterilisation, hand hygiene, and cleaning.
Before retiring, I began doing some editing and proofreading for Bug Control as I am interested in the subject and in the English language. During the COVID-19 lockdown, I attended the ACIPC course "Introduction to Infection Prevention and Control", which increased my interest in the subject. I now work part-time as the Content Editor for the company.
Personally, I lived in the UK for 10 years. My two children were born in Scotland, and now both are living in Europe, one in Amsterdam, Netherlands, and the other in Edinburgh, Scotland. I live close to Fairlie on the South Island of NZ, a beautiful part of the country, and I love being out of the city.
Princess
Customer Support
Princess began her career as a dedicated Customer Service Representative, honing her communication and problem-solving skills. She later transitioned into a Literary Specialist role, where she developed a keen eye for detail. Her journey then led her to a Sales Specialist position, where she excelled in client relations.
Now, as a Customer Support professional in Infection Prevention Services. Princess focuses on ensuring customer satisfaction, building loyalty, and enhancing the overall customer journey.
Princess began her career as a dedicated Customer Service Representative, honing her communication and problem-solving skills. She later transitioned into a Literary Specialist role, where she developed a keen eye for detail. Her journey then led her to a Sales Specialist position, where she excelled in client relations.
Now, as a Customer Support professional in Infection Prevention Services. Princess focuses on ensuring customer satisfaction, building loyalty, and enhancing the overall customer journey.
Dianne Newey
Senior Infection Prevention and Control Consultant
Dianne is a Senior Clinical Consultant at Infection Prevention Services (IPS), bringing over 35 years of nursing experience and a depth of clinical knowledge that most people would need two careers to accumulate.
Having served as Clinical Director at Royal Ryde Rehabilitation Hospital alongside a career spanning the full breadth of clinical practice, Dianne has seen it all — and more importantly, knows exactly what to do about it. She is the person in the room that everyone quietly hopes will speak first.
For more than seven years she has been a cornerstone of the IPS team, providing clinical advice, developing and reviewing policies and procedures, delivering monthly IPC webinars to IP Leads, and conducting environmental audits in aged care facilities across Australia and New Zealand. If infection prevention has a question, Dianne almost certainly has the answer — and she'll deliver it with a laugh that you'll hear from the other end of the corridor.
A true fountain of knowledge, wrapped in the kind of warmth and humour that only three decades of nursing can produce. Customers don't just trust Dianne — they look forward to hearing from her.
Dianne is a Senior Clinical Consultant at Infection Prevention Services (IPS), bringing over 35 years of nursing experience and a depth of clinical knowledge that most people would need two careers to accumulate.
Having served as Clinical Director at Royal Ryde Rehabilitation Hospital alongside a career spanning the full breadth of clinical practice, Dianne has seen it all — and more importantly, knows exactly what to do about it. She is the person in the room that everyone quietly hopes will speak first.
For more than seven years she has been a cornerstone of the IPS team, providing clinical advice, developing and reviewing policies and procedures, delivering monthly IPC webinars to IP Leads, and conducting environmental audits in aged care facilities across Australia and New Zealand. If infection prevention has a question, Dianne almost certainly has the answer — and she'll deliver it with a laugh that you'll hear from the other end of the corridor.
A true fountain of knowledge, wrapped in the kind of warmth and humour that only three decades of nursing can produce. Customers don't just trust Dianne — they look forward to hearing from her.
Caoimhe (Keva) Stewart
Clinical & Business Operations Manager
Caoimhe is the Clinical & Business Operations Manager at Infection Prevention Services (IPS), bringing a clinical background as a Registered Nurse across the UK and Australia — and an almost unsettling ability to make technology do exactly what she wants.
With experience in Occupational Health, Palliative Care, and Community Nursing, she understands the real challenges faced by healthcare teams. What she may lack in stature she more than makes up for in impact — Caoimhe is the kind of person who walks into a problem, sizes it up, and has three solutions before anyone else has finished reading the brief.
Customers love her. Not just because she delivers — though she always does — but because she genuinely cares about the outcome on the other side. She is passionate about creating seamless learning experiences and empowering organisations with the tools, knowledge, and support needed to strengthen infection prevention practices and improve care outcomes.
Small in size. Mighty in results. Completely irreplaceable.
Caoimhe is the Clinical & Business Operations Manager at Infection Prevention Services (IPS), bringing a clinical background as a Registered Nurse across the UK and Australia — and an almost unsettling ability to make technology do exactly what she wants.
With experience in Occupational Health, Palliative Care, and Community Nursing, she understands the real challenges faced by healthcare teams. What she may lack in stature she more than makes up for in impact — Caoimhe is the kind of person who walks into a problem, sizes it up, and has three solutions before anyone else has finished reading the brief.
Customers love her. Not just because she delivers — though she always does — but because she genuinely cares about the outcome on the other side. She is passionate about creating seamless learning experiences and empowering organisations with the tools, knowledge, and support needed to strengthen infection prevention practices and improve care outcomes.
Small in size. Mighty in results. Completely irreplaceable.
Bridgette Mackie
Clinical Nurse Educator
Bridgette is an experienced New Zealand Registered Nurse, qualified Healthcare Auditor, and Healthcare Educator with a strong background in clinical quality, competency assessment, and infection prevention. She has led large-scale OSCE and CAP training programmes for internationally qualified nurses, developed sector-specific educational resources, and coordinated HealthCERT audit preparation in the surgical sector.
Known for her engaging teaching style and genuine passion for supporting learners, Bridgette excels at making complex topics accessible and relevant. She blends operational leadership with a deep commitment to professional development and safe, effective practice.
Bridgette is an experienced New Zealand Registered Nurse, qualified Healthcare Auditor, and Healthcare Educator with a strong background in clinical quality, competency assessment, and infection prevention. She has led large-scale OSCE and CAP training programmes for internationally qualified nurses, developed sector-specific educational resources, and coordinated HealthCERT audit preparation in the surgical sector.
Known for her engaging teaching style and genuine passion for supporting learners, Bridgette excels at making complex topics accessible and relevant. She blends operational leadership with a deep commitment to professional development and safe, effective practice.